TY - JOUR
T1 - Learning from success
T2 - the main drivers of the maternal and newborn health transition in seven positive-outlier countries and implications for future policies and programmes
AU - The Countdown to 2030 Exemplars Collaboration
AU - Campbell, Oona Maeve Renee
AU - Amouzou, Agbessi
AU - Blumenberg, Cauane
AU - Boerma, Ties
AU - Bhushan, Himanshu
AU - Ram, Usha
AU - Kumar, Prakash
AU - Agarwal, Ritu
AU - Washington, Reynold
AU - Ramesh, B. M.
AU - Raja, Mitali
AU - Dhupar, Diksha
AU - Kothari, Ashutosh
AU - Alagarajan, Manoj
AU - Gupta, Shoummo Sen
AU - Algur, Kisan
AU - Isac, Shajy
AU - Sripada, Lakshmi
AU - Narayanan, Thirumalai
AU - Tadele, Ashenif
AU - Mulunesh, Shegaw
AU - Hossain, Aniqa Tasnim
AU - Rahman, Ahmed E.
AU - El Arifeen, Shams
AU - Sharma, Sudha
AU - Adhikari, Dadhi
AU - Assarag, Bouchra
AU - El Omrani, Sanae
AU - Bezad, Rachid
AU - De Brouwere, Vincent
AU - Diallo, Mareme
AU - Ka, Aminata
AU - Martinez-Alvarez, Melisa
AU - Kante, Malick
AU - Youssoufa, Lamou Ousseini
AU - Mounkaila, Aida
AU - Mahamadou, Yahaya
AU - Bamogo, Assanatou
AU - Mohamed, Moussa
AU - Dagobi, Abdoua E.
AU - Akseer, Nadia
AU - Black, Robert
AU - Hazel, Elizabeth
AU - Jiwani, Safia
AU - Koon, Adam
AU - Maiga, Abdoulaye
AU - Munos, Melinda
AU - Tam, Yvonne
AU - Walker, Neff
AU - Walton, Shelley
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.
PY - 2024/5/6
Y1 - 2024/5/6
N2 - Currently, about 8% of deaths worldwide are maternal or neonatal deaths, or stillbirths. Maternal and neonatal mortality have been a focus of the Millenium Development Goals and the Sustainable Development Goals, and mortality levels have improved since the 1990s. We aim to answer two questions: What were the key drivers of maternal and neonatal mortality reductions seen in seven positive-outlier countries from 2000 to the present? How generalisable are the findings? We identified positive-outlier countries with respect to maternal and neonatal mortality reduction since 2000. We selected seven, and synthesised experience to assess the contribution of the health sector to the mortality reduction, including the roles of access, uptake and quality of services, and of health system strengthening. We explored the wider context by examining the contribution of fertility declines, and the roles of socioeconomic and human development, particularly as they affected service use, the health system and fertility. We analysed government levers, namely policies and programmes implemented, investments in data and evidence, and political commitment and financing, and we examined international inputs. We contextualised these within a mortality transition framework. We found that strategies evolved over time as the contacts women and neonates had with health services increased. The seven countries tended to align with global recommendations but could be distinguished in that they moved progressively towards implementing their goals and in scaling-up services, rather than merely adopting policies. Strategies differed by phase in the transition framework-one size did not fit all.
AB - Currently, about 8% of deaths worldwide are maternal or neonatal deaths, or stillbirths. Maternal and neonatal mortality have been a focus of the Millenium Development Goals and the Sustainable Development Goals, and mortality levels have improved since the 1990s. We aim to answer two questions: What were the key drivers of maternal and neonatal mortality reductions seen in seven positive-outlier countries from 2000 to the present? How generalisable are the findings? We identified positive-outlier countries with respect to maternal and neonatal mortality reduction since 2000. We selected seven, and synthesised experience to assess the contribution of the health sector to the mortality reduction, including the roles of access, uptake and quality of services, and of health system strengthening. We explored the wider context by examining the contribution of fertility declines, and the roles of socioeconomic and human development, particularly as they affected service use, the health system and fertility. We analysed government levers, namely policies and programmes implemented, investments in data and evidence, and political commitment and financing, and we examined international inputs. We contextualised these within a mortality transition framework. We found that strategies evolved over time as the contacts women and neonates had with health services increased. The seven countries tended to align with global recommendations but could be distinguished in that they moved progressively towards implementing their goals and in scaling-up services, rather than merely adopting policies. Strategies differed by phase in the transition framework-one size did not fit all.
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U2 - 10.1136/bmjgh-2023-012126
DO - 10.1136/bmjgh-2023-012126
M3 - Review article
C2 - 38770812
AN - SCOPUS:85193481747
SN - 2059-7908
VL - 9
JO - BMJ Global Health
JF - BMJ Global Health
M1 - e012126
ER -